Abstract
This study was concluded on paraplegic and tetraplegic patients of all aetiologies except neoplasic, where paralysis developed within 48 hours. All patients were admitted to the rehabilitation department within 90 days after the onset of paralysis. In a preliminary review of 328 files, there were 27 cases of clinical deep vein thrombosis (DVT) and 10 with pulmonary embolism (PE), 6 of which were fatal. A prospective study was conducted, based on systematic detection of asymptomatic DVT with phlebography. Among the 147 patients, 20 previously presented with DVT. The 127 others underwent phlebography which showed 39 DVT in 29 patients. Eighty seven patients with negative phlebography underwent a second study a month later which showed 14 DVT in 12 patients. Only one minor pulmonary embolism occurred in these 147 patients. The incidence of DVT after acute spinal cord injury and the frequent absence of clinical manifestations were confirmed. Prophylactic anticoagulant therapy is useful but insufficient. This study demonstrates that systematic and repeated detection of DVT by phlebography may reduce the incidence of PE.
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Albrechtsson U, Olsson C G 1979 Thrombosis after phlebography: a comparison of two contrast media. Cardiovascular Radiology 2: 9–18.
Bors E, Conrad C A, Massel T B 1954 Venous occulsion of lower extremities in paraplegic patients. Surgery, Gynaecology and Obstetrics 99: 451–454.
Brach B B, Moser K M, Cedar L, Minteer M, Convery R 1977 Venous thrombosis in acute spinal cord paralysis. Journal of Trauma 17: (4)289-292.
Cook A, Lyons H A 1949 Venous thromboembolic phenomena. Their absence in paraplegic and tetraplegic patients. American Journal of the Medical Sciences 218: 155–159.
El Masri WS, Silver J R 1981 Prophylactic anticoagulant therapy in patients with spinal cord injury. Paraplegia 19: 334–342.
Hachen H J 1974 Anticoagulant therapy in patients with spinal cord injury. Paraplegia 12: 176–187.
Hessel S J, Adams D F, Abrams H L 1981 Complication of angiography. Radiology 138: 273–281.
Holden R W, Klatte E C, Park H M, et al 1981 Efficacy of non invasive modalities for diagnosis of thrombophlebitis. Radiology 141: 63–66.
Kakkar V V, Howe C T, Nicolaides A N, Renney J T G, Clarke M B 1970 Deep vein thrombosis of the leg. Is there a ‘high risk’ group? American Journal of Surgery 120: 527–530.
Luizy F, Franceschi C, Franco G 1986 A methodology of venous investigation by real time echotomography associated with directional and continuous wave Doppler. Annales de Medicine Interne 137: 484–487.
Maliska P, Tiercelin G, Vallee C, Baer M, Pasteyer J 1985 Phlebographie prépératoire systématique chez les traumatisés des membres inférieurs opérés tardivement. Annals of French Anesthesia 4: 23–26.
Merli G J, Herbison G, Weitz M H, et al 1988 Comparison of low dose heparin, low dose heparin plus Dihydroergotamine, low dose heparin plus electrical stimulation and placebo as prophylaxis for deep vein thrombosis in acute spinal cord injury. Paraplegia 26: 124–125.
Miller F, Young C, Wang G J 1983 The incidence of thromboembolic disease. Clinical Orthopaedics and Related Research 176: 210–216.
Moreno-Cabral R, Kistner R L, Nordyke R A 1976 Importance of calf vein thrombophlebitis. Surgery 80: 735–742.
Perkash A, Prakash V, Perkash I 1978 Experience with the management of thromboembolism in patients with spinal cord injury: Part 1, incidence, diagnosis and role of some risk factors. Paraplegia 16: 322–331.
Sandler D A, Martin J F, Duncan J S, et al. 1984 Diagnosis of deep-vein thrombosis:comparison of clinical evaluation, ultrasound, plethysmography and venoscan with X-ray venogram. Lancet ii, 716–719.
Silver J R, Moulton A 1970 Prophylactic anticoagulant therapy against pulmonary embolism in acute paraplegia. British Medical Journal 2: 338–340.
Silver J R 1974 The prophylactic use of anticoagulant therapy in the prevention of pulmonary emboli in one hundred consecutive spinal injury patients. Paraplegia 12: 188–196.
Stover S L, Fine P R 1987 The epidemiology and economics of spinal cord injury. Paraplegia 25: 225–228.
Watson N 1978 Anticoagulant therapy in the prevention of venous thrombosis and pulmonary embolism in the spinal cord injury. Paraplegia 16: 265–269.
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Yelnik, A., Dizien, O., Bussel, B. et al. Systematic lower limb phlebography in acute spinal cord injury in 147 patients. Spinal Cord 29, 253–260 (1991). https://doi.org/10.1038/sc.1991.36
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DOI: https://doi.org/10.1038/sc.1991.36